overheard at lunch

A sentence starter unlikely to be heard anywhere other than a medical school for international health:

"Every morning as I walked past the slaughtering of water buffalo on my way to clinic. . . . "

I am sad to say . . .

that no. . . still no special lady time for me.

And I so wanted to believe!

When you know your country is way too small. . .

So first year, in a moment of insanity, I auditioned for a community theater production of Anything Goes scheduled to tour Israel in the spring. I was cast as the lead and spent the rest of the year in a panic, frantically hiding pharmacology cards in my costumes to glance at backstage between scenes and rehearsing dance numbers in my head during microbiology class and generally being underslept, overstretched, and ruing my decision.

I had effectively put the whole experience out of my mind until this afternoon when, sitting in a coffeeshop downtown, out of the corner of my eye I noticed a familiar red dress on the large television screen behind the counter. Casually looking up, I was horrified to see. . . me, dancing in a red velvet dress with a feather boa. I then appeared, just about life-sized (which isn't very big but still), in a slip and my voice, singing "Blow, Gabriel, blow," assaulted me from what felt like ten million hidden loudspeakers.

This commercial for the theater group, featuring a good 90 seconds of garishly becostumed me, was repeated six times as I sat trying to have a very serious (very doctorly of course) group meeting.



Kind of fun. Kind of painful and embarrassing.

Miracles! A personal note

I just received my first email addressed to . . . . Dr. Me And on the residency website they list me as "me," MD. I wonder when this will stop being exciting.

In personal medical news, ever since leaving Israel last summer I have for all intents and purposes dispensed with menstruation (it's been about 10 months now). While I like to believe that my uterus has simply evolved beyond the need for such barbaric and messy practices, I realize that this is probably not indeed my ideal state of being.

I saw my ob/gyn in the states and we're trying out some meds, discussing fertility options. But my husband also insisted I see his Chinese doctor/acupuncturist, Larry. Since he also plays ocean sound music, shiatsus my shoulders, and the room smells like lavender, I have no problem acquiescing.

So Larry takes my pulse, shakes his head and clicks his teeth, asks to see my tongue, looks terribly disappointed in me, and tells me he wishes I had called him when I had my worm troubles because all I needed to do was warm my spleen either externally or with ginger tea, and I could have been symptom-free my entire trip. If only I had known it was my frigid spleen causing all the trouble!

So then, he focuses on my ovaries: massages my tummy for a while ("you have a lot of fire in your liver which is overheating your heart leading to obstruction in your thyroid- I've got to get things moving"), and then he sticks two needles in the webs between my first and second toes, and in both wrists.

About 7 minutes later, he holds his hands over my head for a few minutes and then says, "Okay, you're better now. You'll get your period tomorrow I imagine, and you shouldn't have any troubles with menstruation any more. I've retaught your nervous system how to regulate itself."

Amazing!

Hee. I'll let you know what happens tomorrow. . .

And for your viewing pleasure. . . a polycystic ovary:

depressing but true

Our ortho rounds finished muy early today, leaving me with a whole afternoon free to run, yoga, make salad, do laundry etc.

Having completed all those things I now have three glorious empty hours before bedtime in which to read a new novel, play catch with the dogs, paint my toenails, catch up on 30 rock or Grey's Anatomy, lie on the couch and look at the ceiling. . .

What am I doing?

Studying ahead for residency.

Oh medical school, look what you have wrought.

Squeegees in the storm

Would be a decent to excellent novel title, but I'm stuck after that.

Perhaps you can tell I have some free time these days?



Okay, I know I've ranted about this before but it continues to baffle me. Israelies are excellent at architecture, they're technological masterminds, they can irrigate anything into vibrant fertility (I trust that my husband could make the kitchen floor sprout tomatoes with a Nalgene full of water if the need arose). So I cannot cannot cannot wrap my head around the bathroom design here.

Essentially they take a room, put a hole in the floor, and then stick a shower head, a toilet, and a sink in said room. Perhaps an ornamental shower curtain separates the elements. Perhaps there's even a symbolic ridge on the floor loosely denoting the shower area. But the water in no way is funneled towards the drain and in no way is the shower head one of those yummy rain ones that pours straight down. No, it's generally one of those detachable shower hoses with a penchant for wildly ricocheting from wall to wall when you turn the faucet on. Which really doesn't make a difference since the bathroom is continuously soaked any way.

Now you have to admit it's thrifty, and I do take some pleasure in peeing, brushing my teeth, cleaning the bathroom, and showering simultaneously.

But here's what I hate. After the shower, you're expected, while cold and wet and freshly scrubbed, to grab a giant squeegie on a stick, and futilely attempt to shovel all the water into the drain. I tolerated this in my old apartments, but my new apartment takes things a step further.

So the floor here actually slopes down away from the drain, out of the bathroom, and bottoms out somewhere in front of the living room couch. And the water pours down this slope much faster than the meager little drain can collect it. The end result is that for literally the entire duration of my shower I have to continuously squeegee the water back towards me as I attempt to shampoo, shave, and soap one-handed, or I flood the entire apartment.

This ruins showering for me to such an extent that I chose option B. Flood the Entire Apartment for the first week and a half, until my husband gently informed me that this is not good roommate behavior.

cross cultural miscommunication of the day

Believe me, I am far too deeply familiar with the perils of navigating a second language, and am generally happy just to properly phrase a coffee order without offending anyone around me. So I do my best to be understanding and to not overtly giggle when our Hebrew speaking professors pronounce something wrong or have a spelling error on the board. But today's mistake was just too cute to handle.

The topic of the lecture? Child abuse

The header on the top of every single powerpoint slide?

"Buttered Babies."




Hee.

Oh yeah, that old conflict

In celebration of my almost-doctor status and impending midwesterly relocation, I registered for this year's Indianapolis marathon.

I decided to go out for my first base-building run this afternoon and casually asked my husband if there's a good trail to run on in the area (we're living in a suburb outside Beer Sheva surrounded by desert).

"Sure," he said, "there's a trail that starts right down the road."

I headed off to the bedroom to get changed. He stopped me on my way out the door.

"Wait. . . make sure when you get to the water tower that you don't turn right. That will lead you into an Arab village and they've been shooting towards bikers in that area. And if you get to a fence or a guard tower, you've gone too far and you're in the Palestinian territory."

I had a perfectly lovely sunset desert run (holding rocks in both hands in preparation for the frequent packs of wild desert dogs. [no, seriously]), though I did encounter the relatively anticlimactic fence half an hour in and had to turn back earlier than I planned.

I'll miss this crazy country.

Only in Israel or Ahh, home

Husband: "I know the perfect place to practice driving manual. No traffic, no hills, all you have to worry about is the rockets."

Oh!

And I can drink the tap water!!!!!!!!!!!!!!!!!!!!!!!

The nice thing about coming home from traveling is how impossibly luxurious my everyday life feels. Endless hot water, copious amounts of toilet paper, I almost teared up in the gynecologist's office when I saw the private exam room with it's shiny padded table, clean pink gown, stacks of paper towels on the shelf next to the green tea and lemongrass scented hand soap. It's like I;m living in a 5 star hotel.

I sat in ortho lecture this morning, giggling fondly at the screen (on which the professor had misspelled anesthetized as anestheseized), with a cup of coffee in my hand, the calming hum of the air conditioner in the backgroun, powerpoint slides projected onto a shiny white screen, and just thought wow, my every day life is so unimaginably cushy.

I'm back in Israel now after 4 straight days of flying, interrupted by a 15 hour layover in Lima and a 24 hour stop in MD to pack my bags and wave to my parents.

It's this terrible week of limbo. Tomorrow night I find out if I matched and Thursday tells me where I matched. There's nothing more to be done except wait and go to class and try to remember both basic anatomy and how to practice medicine with resources.

It's hard to know what to do with myself without any tests or interviews or application forms on my horizon. (Although I have a terribly embarrassing confession to make: I picked up a USMLE Step 3 book before I left, it's not till next year and I don't even know if I'll match but I just can't imagine my life without something I should be studying). Well, I've mostly been eating Ben and Jerry's cinnamon roll ice cream and watching every episode of 30 rock consecutively.

Not bad at all.

There's a large ad in the airplane magazine for Lima's first full body prophylactic MRI scanner.

"Perfect for healthy adults and those with no symptoms!" Proclaims the ad.

(Well, perfect for discovering meaningless incidental artifacts that will lead you to subject yourself to weeks of worrying and invasive follow-up testing and appointments and re-scans. . . none of which is covered by insurance since you're not sick. . . oooh hospital administrators, clever clever, I get it.)

Strange contrast to literally 20 hours ago when my patient's family couldn't afford a course of Albendazol (12 cents) for their child with severe anemia secondary to intestinal multiparasitosis.

What a wide and wonderful world it is.

Overheard on the wards: Goodbye Peru

My friend B spent much of her time here on the surgery ward of the regional hospital. By the end of the month, she had essentially taken over wound care for the entire ward, getting to know the patients rather intimately in that time.

While she was reluctant to rock the boat too much, she did feel compelled to make some minor changes to the wound care regimen, which at that point involved peeling off the old dressing (and multiple layers of skin), scrubbing with alcohol, and covering with dry gauze, which would instantly restick to the wound (rinse, repeat). B gently began working her own wound care methods into her routine, the major change being washing with only saline and a touch of iodine instead of the harsh scrubs.

The staff seemed amused and just let her do her thing; the patients were a little disturbed by the lack of alcohol and scrubbing, but B explained to them that the chemicals damage the tissues and actually water is better for the wounds.

Sure enough, some of the wounds really did improve over the month she was there.

So today, B went in to say goodbye. As she was leaving the ward, one of the patients called out after her:

"B! Take me to America with you where you can heal wounds with only water!"

Cute.

It´s the thought that counts?

Overheard at a medical staff meeting in a very small Peruvian town in which the alcoholics anonymous office is quite prominently located in the middle of main street:

"We wanted to let you all know that alcoholics anonymous is strictly confidential and anonymous. Please come see us now at the front of the room if you´d be interested in joining."

Well. . . close enough.

Oh the awkward

As I mentioned before there is a very strick sort of code of formality here, when it comes to introductions and departures and the like.

One of the tenets is that once you have been introduced to someone you must greet them with a kiss on the cheek at every future chance encounter. This happens when a nurse comes into the room to join rounds in the morning, when the waitress comes over to take your order, when a patient that you´ve met before comes in holding their morning sputum sample, etc.

The unfortunate side effect to having lived in Iquitos for over one month is that there are now a gigantic number of human beings whom we have been formally introduced to and are now prone to run into without warning. Thus while sitting here at "cyber coffee" (which, alas, serves no coffee whatsoever) or while eating lunch with my friends or while attempting to cross the street, out of nowhere I´ll feel a tap on my shoulder and turn just in time to intercept an incoming pair of lips, which often make contact before I´ve even registered who this person is.

The double difficult part is that I´m a softypoof and have no ability to ignore the street kids in the plaza selling gum and begging for food. I usually make polite conversation, occasionally buy them an ice cream in exchange for a pack of gum. This apparently counts for a formal introduction as, in the 35 minutes I´ve been sitting here typing, 4 separate children have run in, kissed me, sloppily, and run out.

Charming. I´m starting to be ready to come home.

Headline of a lifetime

My friends and I were enjoying a gander at the lovely Amazon from a bench in our front yard when a homeless man wandered over, sat down uncomfortably close to us (any closer would have been inside my soul, really), opened a newspaper, and started reading.

So engrossed was he, he was utterly oblivious to our stares of discomfort and casual scooting of our bottoms out from underneath him.

Finally, my friend caught a glimpse of the headline of the article he was reading and very nearly fell off the bench laughing.

It was?

Las vaginas imposibles

Really.

/Also an excellent band name, in my opinion.
//Aren´t they all impossible, when it comes down to it?

But you know

For all my eye-rolling and medical student attitude(previous post) you know the next time I´m anxious I will be sticking a 100% cotton ball in my ear and avoiding computer screens.

Neato!

While searching google for an image of a cotton ball in an ear (re: yesterday´s post). I came across this.

The gist of it:

Of all the health benefits that placing a piece of a cotton ball in the ear does
(by recreating the same pressure that the fetus does when it explores its ear
with its finger) the one which occurs the quickest (in minutes) and in all human
beings who have tried this is the relief of anxiety.

I have multiple favorite parts.

-First is the part about the cotton ball increasing the level of medicines in the bloodstream.

-Second is the reply stating that rayon won´t work, only 100% cotton (sort of makes you question the initial statement that the effect is derived by stimulating pressure receptors in the ear).

-Third is that the radiation from computers negates the cotton´s effects. (Clearly).

- My fourth favorite is the line that it works on "all human beings who have tried." First of all, amazing. I mean, amazing. Second, sad for anxious puppies and bunnies.

Okay, my true favorite part is imagining a fetus exploring its ear with its finger. Which naturally leads me to trying to envision an anxious fetus. (Google image got nothing for me there).

I mean I hate to be a cynic but, really.

//But maybe the all time best part is that three google results down from that result is the link: "How do I remove a piece of a cotton ball stuck in my ear?"

Despite the paucity of resources and the lack of a bright shiny exterior, the little health clinic here really strives to do the best, and most modern, medicine they can.

I therefore find the following ritual absolutely charming.

I noticed on newborn vaccination day that all the brand new mommies come in with cotton balls in their ears. Doubting there was an ongoing epidemic of postpartum otitis, I asked the nurse about it. She answered, as though it was the most obvious thing in the world, "The doctors do it so a cold wind doesn´t come in. Then they get cramps and fever and their body hurts."

Of course.

This is now, that was then

Two nights ago we were woken up and rushed out to the hospital to assist an emergency c-section.

The story was arrest of labor, bordering on 8 hours with no progression.

Now there´s no anesthesiologist in Requena (there aren´t even surgeons, the general practicioners do six months of training to be able to perform emergency appendectomies and c-sections) so all surgeries take place with only an epidural.

After about 4 hours of frantically trying to round up the necessary surgical equipment and an IV catheter (which took close to three hours to find on its own) we were ready to go, only to discover. . .
No lidocaine.

Without lidocaine the insertion of the epidural needle is too painful to be realistic, so there was no way to procceed with the surgery.

We were now approaching 12 hours of stalled labor. The only option was to put the woman on a "fast boat" to Iquitos, the nearest large city. This involves a 4 1/2 hour boat ride, a two hour ambulance ride, and then the inevitable delays in the hospital itself to gather the surgical equipment (which the family has to buy for themselves) and round up a surgical team.

Luckily at this point the baby was like "screw this" and decided to poke his head out and be born the normal way.

All ended well, but for the want of one vial of a medicine that abounds in emergency departments throughout America (the laceration cart at both ERs I spent time at has at minimum 4-5 half used vials in it all the time, we routinely throw away 2-3 vials per shift if they´ve been opened too long), this woman and child were nearly lost.

Last day in Requena

My classmates asked me at lunch how my morning went. My reply: "Completely uneventful."

What actually happened this morning was the following (I continued happily vaccinating, 81 children, all the while):

-A four year old boy wandered into the vaccine room, peed into the trash can, walked out. (With approving mother watching). ((With an actual bathroom literally one door away)).

-A stray dog wandered into the vaccine room and knocked over the now-full-of-pee trash can. Wandered out.

-A woman with a plate of hand made cheese balanced on her head stopped and swatted at the stray pee-covered dog (making contact) then entered the vaccine room and attempted to sell me cheese.

-The nurse tech encouraged me, with syringe in hand, to pause for a second and buy an unwrapped, warm piece of cheese. I considered it, considered Brucellosis, continued vaccinating.

-A three year old girl, eyes wide, grabbed her mother and pulled her into the room. Pointing at me, she asked, "Mom! Is that a gringa?"
"Yes," the mom replied, "You can touch her if you want to."
(No, no. You may not touch me. Vaccine clinic. Not a gringa petting zoo.)


Overall an uneventful morning. And a beautiful Requenalicious last day. I´ll miss you little town.

Kid´s Health Fair!

So we actually pulled it off. . . a boom box, several gallons of "yellow cola" flavored kool-aid, a sphygmomanometer, an entire neighborhood of assorted children, and a budget of $35.

What we learned:

1. Be prepared

We advertised not at all, figuring that we were a big enough scene in our whiteness to draw a crowd without help. We bought enough cake and bread for about 300 kids, imagining that there were about 150 or so in the immediate neighborhood and a few more would wander over.

This is the sight that greeted us in the morning. (That would be the sight of a room full of 350+ kids, silently waiting to be entertained).

We quickly scrapped our initial ambitious plan with lots of individual activities and healthcare topics for a looser plan of large group games and simply keeping the kids entertained for a few hours and throwing in some education where we could.

2. Use what you got

Our activities included "fishing" little plastic toys out of bowls of water, bowling with a ball of socks and empty water bottles, throwing a soccer ball into a laundry hamper, and a ring toss with large water bottles and rolls of masking tape.

Elizabeth demonstrating the ring toss

All cheap, available pretty much anywhere, and kept the kids entertained for more than two hours.

3. Have something for the parents

We made a poster about high blood pressure and did free blood pressure checks. Simple, useful, gives us some health care worker cred, and helps get the adults in the community involved.

4. Choose one theme

We went in way too optimistic. We wanted to cover crossing the street, dental care, person hygiene, good nutrition, parts of the body. . . we had a page long list of topics to cover. With just five of us, the age range, the language issue, and that many kids, it would have been insanity.

Instead we settled on hand-washing as the theme of the day. We made a poster, talked about it in the morning when they were all sitting and then we asked them questions about hygiene for prizes in between games. Later, they all had to show us good handwashing skills before the snack.

5. Embrace chaos

Baby in the "bowling" lane

Kids are kids.

6. Give out stickers

I can´t emphasize this one enough.

Kids go nuts for stickers.

Sound advice

A large "health and safety" poster hangs above the doctor´s desk. It includes loads of helpful tips (with delightful illustrations).

Some are great:
-Wash your hands before you eat.
-Look both ways when crossing the street.
-Don´t go to the bathroom inside your home and then eat there.
-Don´t drink water that is contaminated with poop.

Some are on the obvious side:
-Don´t look directly at the sun
-Don´t pet dogs that often bite people

And my all time favorite:
-Don´t squeeze lemon juice into your eyes.

Excellent, excellent advice poster.

A little disturbing

We spent the afternoon at a one-year birthday party. Among the clown-filled and generally creepy festivities was a dance contest. All contestants were female and 6 or 7 years old. The videos are sideways, but I think you get the general idea. All the moms clapped and smiled. My friend and I did our best to keep our faces neutral. I imagined that Peruvians were born with world-class booty shaking ability, apparently it´s the result of years of training.